Unknown Individual – Neurology Physician, NPI 1487613642

Unknown Individual is a healthcare provider. based in Daytona beach, Florida. specializing in Neurology Physician. They hold a License No. ME0034710 (FL). The NPI Number for Unknown Individual is 1487613642

Main info

Organization
Inactive
53 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1487613642
Phone
(386) 274-2000
Address
1430 MASON AVE
Deactivation Date
22 May 2024

Doctor Profile

Medical School Name
OTHER
Secondary Phone
3862742000
Graduation Year
1973 (53 years ago)
PAC ID
6901825520
Group Practice PAC ID
7618108978
Professional Enrollment ID
I20051114000319
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 1430, Mason Avenue, Daytona Beach, Volusia County, Florida, 32114, United States

    DAYTONA BEACH, FL 321174551

    Phone: (386) 274-2000

    Fax: (386) 274-2009

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
72148Mri scan of lower spinal canal without contrast4040$0
72141Mri scan of upper spinal canal without contrast1717$0
View full utilization report →

Insurance plans in this area (ZIP 32117)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 7618108978View full group profile
NameSpecialtyState
Physical Therapist In Private PracticeFL
Nurse PractitionerFL
-FL
Family PracticeFL
Pain Management, Interventional Pain Management, Anesthesiology, Interventional Pain Management, Pain Management, AnesthesiologyDE
Nurse PractitionerFL
Physical Medicine And Rehabilitation, Interventional Pain Management, Pain ManagementFL

Reviews

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Frequently asked questions

What unique ID ties claims to Unknown Individual?
NPI 1487613642 is assigned to Unknown Individual under the national enumeration system.
How do I interpret inactive records for Unknown Individual?
Treat inactive as a signal to verify Unknown Individual through official channels.
What field does Unknown Individual work in?
You can think of Unknown Individual as practicing within Neurology Physician. Clinical services aligned with this taxonomy classification.
Does Unknown Individual practice in Florida?
You will see Daytona Beach, Florida on file for Unknown Individual alongside any extra practice locations.
What if Daytona Beach, Florida seems incomplete?
Street-level detail can be omitted — open the full address list for this NPI.

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